Who Is Using Healthcare, and How?

According to the national surveillance study conducted by the Ministry of Health, Labor and Welfare (MHLW), the estimated number of patients who received medical care at a medical institution as of October 2006 was 1,463,000 for those who were admitted as patients and 7,092,000 for those who were treated as outpatients. Looking back at past records, the number of admitted patients increased until 1990 but then decreased from 2003 onward—and this downward trend is still occurring.

Among the 7,092,000 outpatients, 1,866,000 (26.3%) visited a hospital, 3,949,000 (55.7%) visited a clinic and 1,277,000 (18.0%) visited a dental clinic. The overall number of outpatient visitors to hospitals has decreased since 1999, but the amount of patients who have utilized clinic services has increased.

In the past, many patients, particularly the elderly, opted to receive care from an acute-care hospital instead of a clinic—even for minor disease—but data now show patients are visiting clinics instead. The referral system, in which patients are sent from a clinic to a large hospital, apparently gradually has changed the patient mindset and led many to visit a clinic first. This trend actually was a goal of the government, and it appears to be working to the government’s favor.  

Another interesting trend is occurring among the medical institutions themselves. As of October 2006, there were 173,200 active medical institutions, among which there were 9,026 hospitals and 97,442 clinics (this number doesn’t include dental clinics). (Note: A hospital is defined as a facility that has more than 20 beds, whereas a clinic has fewer than 20 beds, if any at all.) The number of hospitals has decreased since 1990, when the peak number was 10,096; clinics, on the other hand, have increased since 1988. The number of general acute-care hospitals total 7,952 (excluding psychiatric facilities and those specializing in tuberculosis).

Within these facilities, the number of orthopedic, cardiology, neurology and respiratory units has increased while the amount of pediatric, obstetric/gynecologic and general surgery units has decreased. One reason for the latter development is that the tough working conditions for those specialty units has made some young physicians shy away from those specialties. Consequently, the shortage of specialized physicians in pediatrics and obstetrics/gynecology is becoming a serious social problem in Japan.

Yoshio Mitsumori is the president and CEO for Tokyo-based ADMIS, a consultant specializing in the medical device industry. He has more than 25 years of experience in the medical industry, including positions with the Itochu Corp., U.S. Surgical, National Medical Enterprises and Century Medical. A member of RAPS, he has spoken at many industry events and worked extensively in international trade of medical products and technologies. He can be reached at [email protected].